POS1463 TUBERCULOSIS AS A FATAL OUTCOME IN PATIENTS WITH RHEUMATIC DISEASES: AN AUTOPSY-BASED STUDY
Authors: M. J. Mantilla Ribero, J. C. Santacruz Devia, J. Londono, A. M. Santos, S. A. Serrato, J. C. Mantilla
Journal: Annals of the Rheumatic Diseases (2022)

Background Tuberculosis (TB) is still a worldwide health problem and patients with rheumatic disease (RD) have an increased risk of this infection and fatal outcomes. Objectives We aim to report an autopsy case series in patients with an RD whose deaths were caused by TB in a high-level hospital of the Colombian north-east and stress the importance of autopsy as a teaching and research tool. Methods A retrospective, descriptive study of the database from the Pathology Department at UIS in Bucaramanga, Colombia. A total of 3390 autopsies were performed between January 2009 and December 2019 in patients whose death occurred at Hospital Universitario de Santander. A total of 1713 autopsy reports were analyzed, of which 10 corresponded to patients with RD whose deaths were caused by Mycobacterium tuberculosis. Results A total of 12 patients with a premortem diagnosis of RD were included who additionally had autopsy findings consistent with a mortal infection by a Mycobacterium tuberculosis. Nine cases (75%) were male and 3 were female (25%). The mean age was 49 years old with a range from 32 to 69 years old. The most common RD was rheumatoid arthritis (33,3%) followed by systemic lupus erythematosus, dermatopolymyositis and gouty arthritis with 2 cases (16,6%) each one. In 9 cases the autopsy findings were extrapulmonary TB, of which more than half were disseminated and only 3 cases were exclusively pulmonary TB. All patients were receiving immunosuppressive therapy. The most commonly used therapies were prednisone (100%), methotrexate (25%), and anti-TNF agents (16,6%). A detailed description of the reported cases is displayed in Table 1 and Figure 1. Table 1. Description of the reported cases Case Sex Age RD IST Autopsy findings 1 Male 32 RA PRED, MTX, Anti-TNF Disseminated tuberculosis 2 Male 37 DMPM PRED Disseminated tuberculosis 3 Female 42 SLE PRED Disseminated tuberculosis 4 Male 43 DMPM PRED, MTX Pulmonary tuberculosis 5 Male 45 GA PRED Meningeal tuberculosis 6 Male 45 RA PRED Meningeal tuberculosis 7 Male 49 GA PRED Pulmonary tuberculosis 8 Male 53 PV PRED, AZA Pulmonary tuberculosis 9 Female 56 RA PRED, Anti-TNF Miliary tuberculosis 10 Male 57 SLE PRED Disseminated tuberculosis 11 Male 60 RA PRED, MTX Pulmonary tuberculosis and tuberculous endocarditis 12 Female 69 SSc PRED Pulmonary and meningeal tuberculosis RD= Rheumatic Disease; RA= Rheumatoid Arthritis; DMPM= Dermatopolymyositis; SLE= Systemic Lupus Erythematosus; GA= Gouty Arthritis; PV= Pemphigus Vulgaris; SSc= Systemic Sclerosis; IST= Immunosuppressive therapy; PRED= Prednisone; MTX= Methotrexate; Anti-TNF= Tumor Necrosis Factor Inhibitor; AZA= Azathioprine. Figure 1. Pictures of some autopsy findings of the reported cases Conclusion TB remains one of the leading causes of death worldwide and patients with RD have an increased risk of TB as compared to the general population. In patients with rheumatic conditions, TB most commonly presents in its extrapulmonary form likely from the reactivation of latent infection, hence we stress the importance of screening for the most prevalent infections before the initiation of immunosuppressive therapy. The diagnosis and early treatment of latent TB infection are vital to preventing the progression of the disease and avoid fatal outcomes related to this infection. References [1]Hsu C-Y, et al. Comparing the burdens of opportunistic infections among patients with systemic rheumatic diseases: a nationally representative cohort study. Arthritis Res Ther. 2019 Dec12;21(1):211. [2]Faria R, et al. Opportunistic Infections and Autoimmune Diseases. Infection and Autoimmunity. Elsevier; 2015. p. 251–77. Disclosure of Interests None declared